This invention relates to a coordination of injury-inducing revascularization treatment and drug delivery to improve vascularization and increase gene expression.
The morbidity and mortality of ischemic heart disease are directly attributable to myocardial injury as a result of limited blood flow from atherosclerotic narrowing of the epicardial coronary arteries. Transmyocardial revasculaization (TMR) reduces the symptoms and morbidity of patients with end-stage ischemic heart disease (Fleischer et al., Ann. Thorac. Surg. 62: 1051-1058, 1996) IMP involves the use of a high-powered carbon dioxide (CO.sub.2) laser to create transmyocardial channels in regions of critically ischemic tissue. It has been speculated that these channels act as conduits to shunt oxygenated blood from the left ventricle into the extensive intramyocardial vascular plexus. However, an alternative mechanism proposed attributes the healing response to laser injury accompanied by neovascularization and increased collateral perfusion of thermally damaged tissue (Fleischer, supra).